Chest
Pulmonary Complications of Bone Marrow Transplantation
Section snippets
MARROW TRANSPLANTATION
Most BMT is done in persons younger than 40 years, preferably younger than 30, because of the greatly increased incidence of complications with age.4 As seen in Table 1, patients with acute leukemia have increased survival if BMT is performed during complete remission. Also, survival is significantly better in patients with aplastic anemia who have received no transfusions than in those who have received multiple blood products. Transplantation in patients with chronic myelogenous leukemia is
INFECTIOUS PNEUMONITIS
Pulmonary infections are the single most common complication seen in BMT, occurring both early and late after engraftment (Tables 3 and 4).16,17 Cytomegalovirus (CMV) is the most frequent and most virulent organism associated with pneumonitis, with up to 90 percent mortality.16 The diagnosis of CMV pneumonitis is made from culture of lung tissue or from histologic identification of characteristic viral inclusions (intranuclear or cytoplasmic) in macrophages or pneumocytes.18 Change in serologic
NONINFECTIOUS PNEUMONITIS
“Idiopathic pneumonitis” and “interstitial pneumonitis” are terms used by many authors if infectious or other specific causes cannot be found to explain diffuse lung disease occurring after BMT.4,9,16,33 Inductive or conditioning chemotherapy, irradiation, leukemic recurrence, and transfusion reactions are each capable of causing diffuse lung injury, although chemotherapy and irradiation are usually implied diagnoses by exclusion rather than proved entities (Tables 3 and 4).
The relationship of
GRAFT-VS-HOST DISEASE
The importance of GVHD to the respiratory system has only recently been appreciated. Its significance is related to the substantial pulmonary dysfunction in patients having successful BMT and remission from hematologic malignancies.28,29,40, 41, 42 The primary abnormality involves symptomatic, and in some cases, progressive airway obstruction, which is manifested by acute bronchitis or bronchospasm (Tables 3 and 4).
Lymphocytic bronchitis was first reported as a possible pulmonary manifestation
PULMONARY VASCULAR ABNORMALITIES
The clinical significance of vascular abnormalities often found at autopsy in the pulmonary tissue after BMT is probably minimal (Table 3).32,43,45 The incidence of documented pulmonary emboli is quite low, and the emboli have been described as calcific marrow fragments without associated parenchymal damage.45 Venous thromboembolism is probably rare, because most BMT autopsy series do not comment on this entity.32,43,45 Pulmonary thrombi, however, are frequent findings in some series, occurring
DIAGNOSTIC CONSIDERATIONS
Transbronchial lung biopsy, open lung biopsy, and bronchoalveolar lavage have been used in BMT patients in the assessment of pulmonary infiltrates in these immunocompromised hosts.46,47 In a recent prospective study, 22 patients about to undergo open lung biopsy had transbronchial lung biopsy of the lung segment immediately before thoracotomy.46 Transbronchial diagnoses were similar to thoracotomy findings in 58 percent (14 of 24); five tissue samples were inadequate, and five diagnoses were
CONCLUSION
Several practical considerations that can be derived from the studies reviewed should be stressed. The BMT involves young patients with potentially curable hematologic disorders. Even with successful engraftment, pulmonary complications are very common. For months (up to one year or more) beyond engraftment, these patients should be considered to be immunocompromised hosts. Pulmonary disease involving the lung parenchyma and airways can occur both early (within weeks) and late (beyond three
REFERENCES (50)
- et al.
One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation
Blood
(1977) - et al.
Bone marrow transplantation for diseases of childhood
Mayo Clin Proc
(1984) - et al.
Application of bone marrow transplantation in leukaemia and aplastic anaemia
Clin Haematol
(1983) - et al.
Allogeneic bone marrow transplantation for patients with acute nonlymphocytic leukemia
Blood
(1984) - et al.
The pathophysiology and treatment of graft-versus-host disease
Clin Haematol
(1983) - et al.
Cyclosporin-A to prevent graft-versus-host disease: a pilot study in 22 patients receiving allogeneic marrow transplants
Blood
(1983) Acute and chronic graft versus host disease: histopathological evidence for two distinct pathogenetic mechanisms
Hum Pathol
(1984)- et al.
Treatment of cytomegalovirus pneumonia with high-dose acyclovir
Am J Med
(1982) - et al.
Intravenous immunoglobulin for modification of cytomegalovirus infections associated with bone marrow transplantation: preliminary results of a controlled trial
Am J Med
(1984) - et al.
Infection in bone marrow transplantation
Clin Haematol
(1983)
Nosocomial Legionnaires' disease: occurrence in recipients of bone marrow transplants
Am J Med
Hyperfractionated total body irradiation for bone marrow transplantation: results in seventy leukemia patients with allogeneic transplants
Int J Radiat Oncol Biol Phys
Azathioprine-associated pulmonary dysfunction
Chest
Pulmonary infiltrates in leukemia
Chest
Chronic graft-versus-host syndrome in man: a long-term clinicopathologic study of 20 Seattle patients
Am J Med
Alveolar macrophage dysfunction in human bone marrow transplant recipients
Am J Med
Lung function after bone marrow grafting
Int J Radiat Oncol Biol Phys
Bone marrow transplantation in clinical hematology (editorial)
Mayo Clin Proc
Bone marrow transplantation for acute nonlymphoblastic leukaemia: a survey of the European Group for Bone Marrow Transplantation (EGBMT)
Br J Haematol
Marrow transplantation for acute lymphoblastic leukemia
Semin Hematol
Marrow transplantation for acute nonlymphocytic leukemia after treatment with busulfan and cyclophosphamide
N Engl J Med
A review of the current status and techniques of allogeneic bone marrow transplantation for treatment of leukaemia
J Clin Pathol
Immature T lymphocytes in the peripheral blood of bone marrow transplant recipients
Transplantation
Immunologic, clinical, and pathologic aspects of human graft-versushost disease
Mayo Clin Proc
Cyclosporin A as prophylaxis against graft-versus-host disease in 36 patients
Br Med J
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2019, Biology of Blood and Marrow TransplantationCitation Excerpt :In a retrospective analysis, the 2-year cumulative incidence of delayed onset noninfectious pulmonary complications was 10% among 438 patients surviving for more than 3 months [22]. In patients surviving for more than 2 years, Bathia et al. [23] found a 15.1-fold increased risk of late mortality due to ventilatory impairment compared with the general population, and several studies have reported a 30% to 60% lifetime risk of chronic pulmonary dysfunction in long-term alloTX survivors [24–26]. A precise identification of pretransplant factors associated with worsening PFT would allow the identification of high-risk patients and those who might benefit from preventive strategies.